Phases of Phenomenologic Nursology
Phase I: Preparation of the Nurse Knower For Coming to Know
This method engages the investigator as a risk taker and as a “knowing place.” Risk taking necessitates decision. Decision imposes confronting ambivalence in one’s self. The ambivalence of wanting to be “all-at-once” responsible and dependent. Superimposing an already accepted and acceptable structure on data is safe feeling. Approaching the situation or data openly, letting the structure emerge from it, not deciding what to look for, being willing to be surprised, give feelings of excitement, fear, and uncertainty. There exists the possibility that our humanness may include the dilemma of our not being able to perceive the messages of our data, that we will not be able to merge with it and become more. The question arises, Are we knowing places that can relate to otherness and intuitively synthesize knowledge? This process of accepting the decision to approach the unknown openly is experienced as an internal struggle and we become consciously aware of our rigidity and satisfaction with the status quo. Conforming to the usual, in this case positivism, gives a security that is not easily relinquished despite the advantages of actualizing our unique responsible freedom.
Russell’s metaphorical phrase, “windows always open to the world,” depicts the sought state of mind. His elaboration on this phrase gives the flavor of the process of preparing the mind. He says, “Through one’s windows one sees not only the joy and beauty of the world, but also its pain and cruelty and ugliness, and the one is as well worth seeing as the other, and one must look into hell before one has any right to speak of heaven.”[12] Pain, cruelty, ugliness, hell seem appropriate words to convey seeing our long-cherished ideas and values, our security blankets, as only false gods. Nietzsche in speaking of confrontation of one’s values said, “And now only cometh to him the great terror, the great outlook, the great sickness, the great nausea, the great seasickness.”[13] So this human methodology seeks a condition of being in the investigator. The investigator must be aware of her own angular view and democratically open to giving the angular views apparent in the data, the called for representation.
The first phase of this method of research correlates well with the struggle experienced by me in clarifying my approach to patients in public health, medical-surgical, and psychiatric mental health situations. In these situations, one truly has to struggle with democratically keeping one’s windows open to the world. And this is a continual process. Having experienced this struggle in clinical nursing made this approach to research valid and meaningful to me.
Preparing the mind for knowing in clinical or research endeavors may be accomplished by several means. One means is by immersing one’s self in dramatic and literary works and contemplating, reflecting on, and discussing them as they relate to the knower’s already known, in this case, nursing practice. In clinical or research nursing the selection of literary works to stimulate the opening of one’s human view is based on their presentation, depictions, and descriptions of man’s nature. In literature authors share their thoughts as men and present possible ways men may view and relate to their worlds.
Phase II: Nurse Knowing of the Other Intuitively
Bergson conceives of man knowing through a dilatation of his imagination getting inside of, into le durée, into the rhythm and mobility of the other. Living the rhythm of the other he believes results in an absolute, intuitive, inexpressible, unique knowledge of the other. He says:
“… an absolute can only be given in an intuition, while all the rest has to go with analysis.”
“… from intuition one can pass on to analysis, but not from analysis to intuition.”
“… fixed concepts can be extracted by our thought from the mobile reality; but there is not means whatever of reconstituting with the fixity of concepts the mobility of the real.”[14]
The known, clinical nursing practice, gave meaning to the above for me. Over the years in nursing conferences I had been told my grasp of nursing situations was intuitive. Most times this was offered rather disparagingly although the nursing outcomes were most times successful. Along with having the attribute of intuition assigned to me persons often asked, “Why are you so fascinated with other persons’ situations?” Together these relate to Dewey’s view of intuition. He views intuition as a mulling over of conditions and a mental synthesis that results in true judgments since the controlling standards are intelligent selection, estimation, and problem solution.[15] In nursing practice research knowing the other and how he experiences and views his world is viewed as the problem.
Knowing intuitively, as described by Bergson, is comparable to Buber’s considerations of man’s necessary mode of becoming through “I-Thou” relation. The criteria Buber describes as characteristic for “I-Thou” relation are subscribed to in my approach to nursing practice and in this human or phenomenological nursology approach.[16] Buber held as prerequisite for intuitive type knowing of the other, or imagining the real of his potential for being, a knower, and “I,” capable of distance from the other, able to see the other as a unique other, one who turns to the other, makes his being present to the other, and allows the other presence. The knowing, “I,” in this case the nurse, responds to the other’s uniqueness, does not superimpose, maintains a capacity for surprise and question, and is with the other, as opposed to “seeming to be.” This kind of relating cannot be superimposed on a nurse clinician or researcher. It must be personally responsibly chosen and invested in.
The approach then of the second phase of this method and of the transactional phase of nursing when nurses are in the arena with others is the same. This method proposes that to study nursing from outside the arena for purposes of objectivity bursts asunder the very nature of nursing practice. The studier is a part of that which is being studied. Observations interpreted from outside the situation could be classified only as projections.
Phase III: Nurse Knowing the Other Scientifically
Bergson believes man knows incompletely through standing outside the thing to be known, metaphorically walking around it, and observing it. This analytical process, this viewing of a thing’s many aspects, he conceives as the habitual function of positive science. This is the third phase of this phenomenological nursology method. Bergson says:
“… analysis multiplies endlessly the points of view … to complete the ever incomplete representation.”
“All analysis is thus a translation, a development into symbols, a representation taken from successive points of view.”
“Analysis … is the operation which reduces the object to elements already known, that is, common to that object and to others.”[17]
So phenomenological nursology proposes that after the studier has experienced the other intuitively and absolutely, the experience be conceptualized and expressed in accordance with the nurse’s human potential. Humanly we can express only sequentially while our actual experienced lived worlds flow in an “all-at-once” fashion. Our words are known symbols and categories used to convey the experience and thus deny the uniqueness of each realized experience.
Buber’s description of man’s “I-It” way of relating to the world is in agreement with Bergson. He conveys the necessity of this kind of relating by man to his world; and despite its lacks proposes that man prize his analytical ability. Like Bergson, Buber views knowing as a movement from intuition to analysis, and not the other way around. Buber sees knowledge expressed or science created through the knowing “I” transcending itself, recollecting, reflecting on, and experiencing its past “I-Thou” relation as an “It.” This is man being conscious of, looking at, himself and that which he has taken in, merged with, made part of himself. This is the time when he mulls over, analyzes, sorts out, compares, contrasts, relates, interprets, gives a name to, and categorizes.
The third phase of this methodology is the same as that phase of clinical nursing practice in which the nurse, removed from the nursing arena, replays and reflects on this area and transcribes her angular view of it. In this reflective state the nurse analyzes, considers relationships between components, synthesizes themes or patterns, and then conceptualizes or symbolically interprets a sequential view of this past lived reality. The challenge of communicating a lived nursing reality demands authenticity with the self and rigorous effort in the selection of words, phrases, and precise grammar.
Phase IV: Nurse Complementarily Synthesizing Known Others
In this phase of the methodology the nurse researcher, the knower, compares and synthesizes multiple known realities. Buber says of comparison:
“The act of contrasting, carried out properly and adequately, leads to the grasp of the principle.”[18]
In this comparison and synthesis the “I” of the researcher assumes the position of the knowing place. The knower, like an interpreter, allows dialogue between the multiple known realities. These realities are unknowable to each other directly. The knower interprets, sorts, and classifies.
In the human knowing place discovered differences in similar realities do not compete, one does not negate the other. Each can be true, present, “all-at-once.” Differences can make visible the greater realities of each. Desan, the philosopher, says of this kind of synthesis:
“… a synthetic view where two or more positions are seen to illuminate and to transfigure one another through their mutual presence.”[19]
The knower alert to an aspect present in a single reality can question the other reality on this aspect. This aspect may be present in both, more blatant in one than in another. Its forms may be different or modified in each. It may be totally absent in one. Differences found may arouse or bring to consciousness other questions to ask of the data. This oscillating, dialectical process continues throughout reflection on the multiple realities. This indirect dialogue is recorded by the investigator as the complementary synthesis.
This synthesis is more than additive because it allows mutual representation and the illumination of one reality by another.
The fourth phase of this research methodology is like that phase of clinical nursing in which a nurse compares and synthesizes the similarities and differences of like nursing situations and arrives at an expanded view.
Phase V: Succession Within the Nurse From the Many to the Paradoxical One
This phase of phenomenological nursology is highly probable if not absolutely necessary. Desan says:
“Truth emerges in and through the relational operation. For the
way of paradox is the way of truth.”[20]
The investigator may struggle with the multiplicity of views now consciously part of and within herself. Again Desan:
“… this unrest “is” the mind of man, reaching its center….
From this center the splendor of multiplicity is visible.”[21]
The researcher, mulling over and considering the relationships between the multiple views, insightfully corrects and expands her own angular view. This is not a right-wrong type of correction. Such correction would amount only to an ongoing eternal recurrence of a frustrating nature. Rather this correction takes the form of ever more inclusiveness. Struggling with the communion of the different ideas the knower takes an intuitive leap, through and yet beyond these ideas, into a greater understanding. She then may come up with a conception or abstraction that is inclusive of and beyond the multiplicities and contradictions.
This inclusive conception or abstraction is an expression of the investigator in her here and now, with the old truths and the novel truths, none obliterated.
The fifth phase of this phenomenological nursology method can be equated to that phase of clinical professional nursing in which the nurse propels nursing knowledge forward. In this phase a nurse struggling with the mutual communion of multiple nursing situations arrives at a conception that is meaningful to the many or to all. From the specific concrete ideas of the many situations she moves through dilemma to resolution which is nursing expressed abstractly in units or as a whole, as one.
Experiential knowledge of nursing, years in which I came to know self and the other while implementing scientific facts, allowed me as a knower to recognize the relevance of this philosophical nursology method. This method does not aim at conventionality. Rather it strives to meaningfully augment and share conceptualized nurse-world realities.
Footnotes
[1] Josephine G. Paterson, “Echo into Tomorrow: A Mental Health Psychiatric Philosophical Conceptualization of Nursing” D.N.Sc. dissertation, Boston University, 1969.
[2] Josephine G. Paterson “From a Philosophy of Clinical Nursing to a Method of Nursology,” Nursing Research, Vol. XX (March-April, 1971), pp. 143-146.
[3] Abraham Kaplan, Conduct of Inquiry (San Francisco: Chandler Publishing Co., 1964), p. 23.
[4] Plato, The Republic, trans. Francis MacDonald Cornford (New York: Oxford University Press, 1945), p. 45.
[5] James Agee, Let Us Now Praise Famous Men (New York: Ballantine Books, 1939), pp. 91-102.
[6] Johann Wolfgang von Goethe, “On Originality.” In Great Writings of Goethe, ed. Stephen Spender (New York: Mentor Press, 1958), p. 45.
[7] C. G. Jung, Modern Man in Search of a Soul, trans. W. S. Dell and Cary F. Baynes (New York: Harcourt, Brace and World, 1933), p. 118.
[8] Henri Bergson, “Time in the History of Western Philosophy,” in Philosophy in the Twentieth Century, ed. William Barrett and Henry D. Aiken (New York: Random House, 1962), p. 252.
[9] Will Durant and Ariel Durant, Lessons of History (New York: Simon and Schuster, 1968), p. 102.
[10] Hermann Hesse, Demian, trans. Michael Roloff and Michael Lebeck (New York: Harper & Row, 1965), p. 4.
[11] Martin Buber, Between Man and Man, trans. Ronald Gregor Smith (Boston: Beacon Press, 1955), p. 93.
[12] Bertrand Russell, The Autobiography of Bertrand Russell, 1914-1944 (Boston: Little, Brown and Co., 1968), p. 97.
[13] Frederick Nietzsche “Thus Spake Zarathustra,” trans. Thomas Common, in The Philosophy of Nietzsche (New York: Random House, 1927), p. 239.
[14] Henri Bergson, “An Introduction to Metaphysics,” in Philosophy in the Twentieth Century, ed. William Barrett and Henry D. Aiken (New York: Random House, 1962), pp. 303-331.
[15] John Dewey, How We Think (Boston: D. C. Heath & Co., Publishers, 1910), p. 105.
[16] Martin Buber, “Distance and Relation,” trans. Ronald Gregor Smith, in The Knowledge of Man, ed. Maurice Friedman. (New York: Harper & Row, Publishers, 1965), pp. 60-82.
[17] Bergson, “An Introduction to Metaphysics,” pp. 303-331.
[18] Martin Buber, I and Thou, 2nd ed., trans. Ronald Gregor Smith, (New York: Charles Scribner’s Sons, 1958). pp. 3-34.
[19] W. D. Desan, Planetary Man (New York: The Macmillan Company, 1972), p. 77.
[20] Ibid.
[21] Ibid., p. 80.
7
A Phenomenological Approach to Humanistic Nursing Theory
Humanistic nursing is dialogical in the theoretical as well as the practical realm. Just as the meaning of humanistic nursing is found in the existential intersubjective act, that is, in the dialogue as it is lived out by nurse and patient in the real world, so the theory of humanistic nursing is formed, in the dialogical interplay of articulated experiences shared by searching, abstracting, conceptualizing nurses.
The theory of humanistic nursing originates from and is continually revitalized and refined by actual nursing experience. But each nurse, as a unique human being, necessarily experiences the nursing dialogue and her nursing world in a unique way. So the development of humanistic nursing theory rests on the sharing of individual unique angular views. And the theory as a totality will become richer, more consonant with reality, as it represents more and more nurses’ views.
So often nurses, even nurses who know that their clinical expertise grew out of their practice, hesitate to share their nursing experiences. They are apt to say deprecatingly, “Oh, that’s only my personal experience.” Yet that is precisely where the value lies, in the uniqueness of human experience. Since each nurse’s description of her nursing experience is a glimpse of a real nursing world, the views cannot justifiably be judged as right or wrong; they simply are. Once the various views are expressed, they can be compared and contrasted, not for the purpose of accepting some and rejecting others but rather in the interest of clarifying each in relation to the other. Such a dialogue of experientially based conceptualizations can result in a complementary synthesis. The process calls for not only a true appreciation of personal experience by each nurse but also commitment to a collaborative effort of open sharing by a genuine community of nurses.
This view, that the development of humanistic nursing practice theory is a dialogical process, has led to our valuing (in fact, insisting on) the description of nursing phenomena. We see phenomenological description as a basic and essential step in theory building. Indeed, considering the “state-of-the-art” of nursing theory development, it is the most crucial and immediate need.
Looking back at the historical evolvement of our humanistic nursing approach, it is obvious that we had been using and developing a phenomenological approach for a number of years before we graced our efforts with the impressive label, “Phenomenological Psychiatric Mental Health Nursing,” in a course offered to a group of nurses at Northport Veterans Administration Hospital in April 1972. Although we were aware much earlier that our interests and work were flowing in the general stream of phenomenology, we usually refrained from using the label because it did little to clarify our position.[1] The term has grown less precise with the extension of its use in different disciplines and with variations in methodology.
When we began applying the term “phenomenological” to our work, we learned that to many persons it sounds strange, unpronounceable, foreign; to some forbidding; to others enticing. We later coined the title “humanistic nursing” as being more suitable for it encompasses our general existential bent. However, this change in title does not imply any abandonment of our phenomenological approach. The description of nursing phenomena is as highly prized now as ever. In humanistic nursing, phenomenological and existential currents interrelate. Having an existential view of nursing as a living dialogue influences which phenomena one becomes aware of, experiences, values, studies, and describes. Reciprocally, as one discovers and struggles to describe and develop meaningful ways of describing nursing phenomena, the lived nursing dialogue itself will be continually perfected.
It is more precise to speak of phenomenological methods (in the plural) rather than phenomenological method (in the singular), for, since Edmund Husserl’s original work, the approach has been used by different disciplines. With its spread there has developed a corresponding variation in methodology. This, in a sense, is the beauty of phenomenology: it thrives on variety of perspective; it allows, perhaps requires, individual creativeness; it is always open. In this spirit, ideas are offered here with the hope of stimulating imaginative, critical response, and further development of methodology.
This chapter considers some of the more concrete details of phenomenological methodology as they relate to humanistic nursing. The general approach and procedures discussed below have been used, individually and collaboratively, by Dr. Josephine Paterson and myself with individual and groups of nurses to explore and describe their nursing experiences. They have helped nurses in various levels and types of nursing service to take a fresh look at their practice and make desirable changes. We have lived through the process with graduate students in nursing, and it has led both the students and us to new conceptualizations and reconceptualizations of nursing phenomena. We have found this to be a fruitful research method when applied to clinical nursing phenomena personally experienced and/or reported in the literature. And we are currently exploring its potentials with interested nurses at Northport Veterans Administration Hospital.